Question:1. Prior to a transplant, is life-long abuse of the individual organ considered in the decision-making process?2. If there is a choice between two patients, one who took care of an organ, but it fails and theother who abused it, who gets the organ?Answer (- see also below):The answer to both your questions is: NO, whether one's conditions is self inflicted or not is not considered when allocating organs. Basing allocation on a judgment of whether one's condition was self-inflicted is simply not possible. Supposing that it is possible is far too simplistic a view. Where would the line be drawn between someone that is "worthy" to receive an organ and someone that had created their own problem and was therefore not "worthy"?

Show me one adult human being alive that has never done something that was known to be contrary to their health. Well, one little steak with fries and lots of salt didn't cause anyone to get high blood pressure and kidney failure and heart disease, did it? How about eating these foods once a week; once a night? How about one glass of wine a night? An occasional binge with the gang? Cigarettes that were smoked in an era when everyone else smoked? What if someone was "stupid" enough not to quit their job if it caused them to be exposed to a hazard, like second-hand smoke? All of these behaviors cause diseases that may be treatable by transplantation. What about the person that foolishly didn't adhere to his doctor's advice to have a treatment that may have avoided the need for a transplant? ("If that guy had only taken his blood pressure medicines, he wouldn't have gotten kidney failure, therefore we should withhold a kidney transplant because he is to blame for his disease.") Is such a person less to blame fotheir disease than the person who drank excessive amounts of alcohol when everyonein the room was doing the same thing? Who is going to define just how much abuse was permissible? What about the person that "abused" his heart by choosing to have a job with a high amount of stress? Many occupations are known to be associated with higher rates of heart failure. Do people in those occupations deserve a heart transplant when someone who chose to be a librarian needs the heart as well? What about the person who was abused by their spouse and dealt with it by drinking alcohol to excess? Are they not accountable for their disease? It is known that abused people tend to drink too much. Do we want a medical system that defines exactly how we have to live in order to be judged worthy of care? Organ transplant is THE standard of care for chronic liver, kidney, heart and lung failure.

The amount of alcohol necessary to cause liver failure is extremely variable. It is a misconception to suppose that everyone that has liver failure from alcohol was a worthless boozing leach on society. Most alcoholics are genuinely surprised to find out they have liver failure from too much alcohol because they drink thesame amount as their buddies. Would we be judging them unworthy because of the fact that their disease was self- inflicted, or because they were too naive to realize they had a disease? There are people that probably could not drink enough alcohol to damage their liver if they had to, and there are people that can get liver disease from 4 drinks a day.

Organs are allocated based on need, fairness, and the likelihood that the organ will succeed in restoring health. Patients that continue to abuse a substance are not candidates for transplants. Patients that attend alcohol rehabilitation, and are able to change their ways, are candidates to receive a life-saving organ. If wewere to hold them accountable for past mistakes, we would be forced to hold every transplant patient accountable for their mistakes out of fairness, and this would not be possible. In general, if a patient does not follow medical advice when caring for a transplanted organ, they are not a candidate for a retransplant, whereas those who take care of their organs can rejoin the list of those waiting if a retransplant is required.

Jeff Punch, MD (University of Michigan)

Abuse/non-abuse of organs is not taken into consideration at the UNOS level. The organs are allocated according to a fairly complicated system of how sick the recipients are, how long they've been waiting, and how weel-matched they are with the donor in terms of height, weight, and blood group. the organs are allocated locally, then regionally, then nationally. Before being listed for a transplant, recipients are evaluated as to how well they will take care of their new organs. As an example, alcoholics who need transplants must be sober for 6-18 months before they will even be listed. IV drug abusers, non-compliant patients, etc. will generally not be accepted for transplantation.